Provider Demographics
NPI:1205962644
Name:RISING, PAMELA A (LPN)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:A
Last Name:RISING
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ACUSHNET AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-1866
Mailing Address - Country:US
Mailing Address - Phone:508-853-8334
Mailing Address - Fax:508-853-8334
Practice Address - Street 1:121 ACUSHNET AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1866
Practice Address - Country:US
Practice Address - Phone:508-853-8334
Practice Address - Fax:508-853-8334
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA62782164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0709069OtherPROVIDER NUMBER